For anyone working as an outpatient coder, you’re very aware that January 1 was the date to break in a new CPT® book!  For 2023, there are 393 total changes:  225 new codes, 75 deletions, and 93 code revisions.

The section of CPT® undergoing the most significant changes for 2023 is the Evaluation and Management Section with every E/M code that requires use of documentation guidelines for determination of level of service being revised.  The 1995/1997 E/M Documentation Guidelines are being phased out and are being replaced with guidance instructing the coder that determination of appropriate level of service will be based upon either the assessment of Medical Decision Making for the encounter or upon the provider’s documentation of total time devoted to the encounter.

While these changes are comparable to the ones enacted in 2021 when the codes for Office and Other Outpatient services were revised, be aware that codes have been deleted and there are some significant changes to guidance and definitions PLUS a new table to use that will replace the one published in 2021.  So for any coders responsible for E/M coding on the ProFee side, this will be an area where you will definitely want to spend some time making sure you’re clear on the new processes.

For surgical coders, probably one of the most significant areas of change can be found in the section of codes for repair of anterior abdominal hernias such as epigastric, incisional, ventral, umbilical and Spigelian hernias.  ALL of the previous CPT® codes for these procedures have been deleted and replaced with all new codes that combine surgical approaches, address whether the encounter is for an initial or recurrent repair, and where the codes are now assigned based upon measurements (relax, there is a comprehensive explanation PLUS some very helpful illustrations in the new code book to help you master it)! 

Combine these changes with some tweaks to definitions and guidance for other codes with a few new ones tossed in, the usual complement of new Category III codes for emerging technology as well as a generous assortment of new PLA codes (with lots of new codes for vaccines for COVID-19), and coders have a goodly assortment of new information to master for the new year! 

Be sure to invest a little time in training/review now to ensure that you are on the right track for 2023!

Lisa Greene, CCS, CCS-P

Associate Manager, Consulting Service